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Hospitals in Flux
The Dynamic Nature of Modern Healthcare Environments
Modern hospitals are undergoing major renovations unseen since the last great construction boom following WWII.The actual dynamics of these changes have remained hidden in the face of the over $15 billion a year scope of these changes. MKThink undertook an extensive research project using both primary and secondary data analysis to understand the nature of these dynamics. The goal was to provide the larger health care industry with insight into the nature of these changes. Our research and analysis revealed interesting patterns and led to design recommendations based on these findings.
An MKThink Research Publication
28 July 2005For further information, please contact:Chloe Lauer at 415 288 3394
 
© MKThink 2005. Reproduction prohibited without permission.Hospitals in FluxPage 2
Hospitals in Flux
The Dynamic Nature of Modern Healthcare Environments
F
or many, the modern hospital stands as symbol of technologicalmastery, order, and control in the face of the chaos that illnessbrings to the social fabric. When one lifts the hood on themodern hospital, however, one is struck by just how much fl uxand change is taking place within the halls of these central socialinstitutions.Hospitals are experiencing a wave of construction andrenovation unseen since the construction boom following WWII.Hospital construction activity was measured to be around $15billion in 2003,
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driven largely by decaying and obsoletefacilities, changing patient demographics, seismic codes, andtechnological advances.With approximately 4,800 registered U.S. hospitals,
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thistranslates to approximately $3 million per hospital in constructionand renovation each fiscal year. To put this into perspective, withrevenue per hospital averaging $70 million per year,
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renovationcosts equal almost 4% of yearly hospital revenue. Another way to understand the impact is to look at hospital bedavailability. Each year the total hospital square footage offl inedue to construction is equivalent to 215 entire hospitals. Thescope and scale of these changes is extensive and continues togrow each year.Faced with such extensive change, hospital design is movingaway from traditional “brick and mortar” construction paradigms.The move towards long-term facilities planning, modularity, anddesign around a technology-enhanced workfl ow are all part of aseries of design trends reshaping the architecture of hospitals andthe larger healthcare built environment.
THREE PRIMARY DRIVERS FOR CHANGE
New technologies, increasing focus on patient/family-centeredspaces, and the competitive pressure for services all are forcinghospitals to adjust their physical environments accordingly.
New technologies.
Wireless patient record keeping andincreasingly sophisticated imaging technologies are driving theneed for space allocation dedicated to tech support and ITsystems.As new technologies enter the hospital, work fl ows areinfl uenced. This, in turn, affects planning and space allocations.
Patient/Family Centered Space.
Patients and families areincreasingly demanding a variety of amenities to make theirhospital experience more “home-like,” such as single family roomsand comfortable, hotel-like waiting areas.
Competitive Pressures
. Both the pressure to keep up with thecompetition and the desire to improve efficiencies are forcinghospitals to realign their facilities in the face of increasing fiscalpressures, demographics, and patient needs.These changes in hospital facilities are only expected to increaseover time. The need for hospitals to adapt to these various driversis accelerating. This need creates increasingly dynamic conditionsin the hospital built environment.
SCOPE AND SCALE
The changes taking place in hospital facilities are ubiquitousand extensive. Over 2/3 of U.S. hospitals are in some state oftransition. Of these, most of the hospitals under renovation arelarger—over 240,000 s.f. with 250 or more beds.Project costs vary widely for a given fiscal year, ranging from$110,000 to $100,000,000. Most hospitals are regularlyallocating funds to facilities upgrades and improvements as new
 
Hospitals in FluxPage 3© MKThink 2005. Reproduction prohibited without permission.
technologies, shifting Full Time Equivalents (FTEs), or changingpatient needs put pressure on the extant facilities.In California in particular, State Bill SB 1533, focused on seismicretrofitting, has led to major expansions of hospital renovationand construction. Besides upgrading for seismic retrofitting,many states are mandating changes in hospitals due to outdatedmaterials and higher standards for healthcare excellence.
TECHNOLOGY DRIVES REGULAR CHANGE
Technology is one of the primary drivers of facility change. Inparticular, the increasingly prominent role of complex imagingand diagnostic modeling technologies is demanding an increasein infrastructure support. As these technologies become moresophisticated, new rooms, data cabling, and conduits must becreated in accord with changes to hospital space planning tiedto new workfl ow patterns. In addition, workfl ow patterns basedon the traditional “tower and pancake” model of hospital designwith multiple fl oors dedicated to different specialties often doesnot mesh with the increasingly interconnected and interdisciplinarynature of technology driven healthcare.Because of these shifts in technology, and the obsolescence offacilities, hospitals are making changes due to technology on aregular basis (Figure 1).Roughly 70% of respondents
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reported having had to makechanges over five times per year in their facilities due to outdatedfacilities not meeting the needs of new technologies. New andimproved wireless services, IT services, diagnostics and imaging,electronic medical records, MRI facilities, and catheter labs allrequire major renovation of space to accommodate new workfl ows, or provide room functionality not available in originalconfigurations.A Facilities Manager at a major California Hospital in the BayArea commented, “We continually upgrade our CTs and MRIsto the latest technology. There is always some renovation/construction work required.”
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The bottom line for many facilitiesmanagers is that “patients always need the newest, latest, greatestcare. Technology has to keep up with every aspect of patientcare.”
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The number of these renovations over time illustrates the dynamicnature of the hospital environment driven by technologicalchange. Consistent renovations and regular expenditures due toobsolescence in technology and other factors drive these changesin a way that make the interior environments of modern dayhospitals one of significant fl uidity.
PATIENT/FAMILY CENTERED SPACE
As the hospital amenities competition heats up with increasingdemand from patients and families for comfort and control,hospitals are forced to adjust their rooms to accommodate familyneeds more directly. The overall thrust for many facilities managersin this regard is “making the buildings more patient friendly.[We are] looking for ways to facilitate expansion of communityservices.”
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One of the major changes in alignment with this trend is thecreation of single rooms (Figure 2). The demand for single roomswith accoutrements found in hotel suites is a growing concern formany facilities managers, who feel that they have to “improve thepatient and family experience”
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by creating facilities that matchthe needs of the users.
COMPETITIVE PRESSURES - CHANGING SERVICES
Patient and family demand for particular services, changingservice offerings, and the creations of focus factories (centersof excellence) are key factors driving the needs of facilitiesrenovation.
 
        P     e      r     c      e      n       t     a      g        e 
FIGURE 2:
 
Patient/Family Demand On Hospitals0%20%40%60%80%100%
  S  i  n g    l e   R o o  m s  F a  m  i   l  y   R o o  m s   W a  i  t  i  n g    A  r e a s  S  t a  y o  v e  r   R o o  m s   T e c   h   R o o  m s  H e a   l  i  n g    S  p a c e s
 0%20%40%60%80%100%
        P     e      r     c      e      n       t     a      g        e 
0251010+FrequencyFIGURE 1:
 
Frequency Of Technology Driven Changes,2000-2005 (Per Facility)
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